I live in Massachusetts. I had a series of appointments to have dental work done last year. On my last appointment, after the pre-authorized (by my insurance carrier) work was finished, they did a cleaning. It was a second cleaning in the series of procedures and was too recent relative to the prior cleaning to be covered by my insurance. Consequently, the insurance denied the claim and dentist is looking for $150 for the cleaning.
However, they never explained in any way the purpose of the final appointment, especially:
that it was a cleaning and not a part of the pre-authorized dental work;
the cost of the cleaning;
whether my insurance was likely to cover the cost.
In short, they never gave any explanation regarding the procedure. And when I left the final appointment, they told me my insurance would cover it and I did not need to pay anything. Once the insurer denied the claim, they sought payment from me. For a year I ignored them, and now a lawyer representing them is looking for payment from me. I've got about a week to respond to his request.
My questions are:
1. In general, can someone legally demand payment and be compensated for performing an unauthorized service?
2. Did I implicitly authorize the service by showing up for the appointment and not refusing the cleaning?
3. Could the cleaning be considered an unauthorized service because they did not fully explain the procedure, the cost of the procedure, and whether I would be personally responsible for the amount of the service?
4. Can I be exempted from paying the claim because they did not tell me that I would be personally liable for the amount and, following the said procedure, that my insurance would cover the claim?
5. If I refuse to pay the claim, can the lawyer impair my credit report even though they don't have my SSN (to the best of my knowledge)?
However, they never explained in any way the purpose of the final appointment, especially:
that it was a cleaning and not a part of the pre-authorized dental work;
the cost of the cleaning;
whether my insurance was likely to cover the cost.
In short, they never gave any explanation regarding the procedure. And when I left the final appointment, they told me my insurance would cover it and I did not need to pay anything. Once the insurer denied the claim, they sought payment from me. For a year I ignored them, and now a lawyer representing them is looking for payment from me. I've got about a week to respond to his request.
My questions are:
1. In general, can someone legally demand payment and be compensated for performing an unauthorized service?
2. Did I implicitly authorize the service by showing up for the appointment and not refusing the cleaning?
3. Could the cleaning be considered an unauthorized service because they did not fully explain the procedure, the cost of the procedure, and whether I would be personally responsible for the amount of the service?
4. Can I be exempted from paying the claim because they did not tell me that I would be personally liable for the amount and, following the said procedure, that my insurance would cover the claim?
5. If I refuse to pay the claim, can the lawyer impair my credit report even though they don't have my SSN (to the best of my knowledge)?